Ali Uzunkoy

Incidence and aetiological factors in pilonidal sinus among Turkish soldiers

OBJECTIVE To study the incidence and causes of pilonidal sinus in Turkish soldiers. DESIGN Open study by questionnaire. SETTING Military and University hospitals, Turkey. SUBJECTS 1000 soldiers who presented for their first medical examination. MAIN OUTCOME MEASURES Correlation between factors known to be associated with pilonidal sinus, and incidence of pilonidal sinus. RESULTS 88/1000 soldiers had pilonidal sinuses; in 48 they were symptomatic and in 40 asymptomatic. The factors associated with the presence of a pilonidal sinus were: family history of pilonidal sinus (18/88 compared with 32/912, p < 0.0001); obesity defined as weight over 90 kg (34/88 compared with 32/912, p < 0.0001); being the driver of a vehicle (58/88 compared with 308/912, p < 0.0001); and the incidence of folliculitis or a furuncle at another site on the body (22/88 compared with 64/912, p < 0.0001). CONCLUSIONS Pilonidal sinus is an acquired condition, penetration of hair is the main cause, and the disease can be prevented if the aetiological factors are understood.

Simple and effective surgical treatment of pilonidal sinus

PURPOSE: This study was planned to evaluate prospectively the results of 112 pilonidal sinus cases treated surgically by using asymmetric excision and primary closure with suction drain and subcuticular skin closure. It is aimed at elimination of the causative factors of pilonidal sinus. METHOD: The patients age, profession, weight and height, symptoms and signs, duration of symptoms, previous treatments, operation time and cost, hospital stay, return to normal activity, complications, pathologic and microbiologic examinations, and recurrences were noted. All pilonidal sinus cases except pilonidal abscess and extensive gluteal involvement were treated surgically. The procedure consists of an eccentric, elliptical excision of the affected tissue, mobilization of the flap to the sacrococcygeal fascia and the suturing of its edge to the lateral one. Penrose drains were placed in the first eight (7.14 percent) cases, but suction drains were placed in others. The cases were followed up for a mean of 2.4 years. RESULTS: Twenty-eight (25 percent) cases had undergone previous operative procedures. Of 112 patients 106 (94.6 percent) were male. Mean age was 22.1 years. Mean history of disease was 4.2 years. The overall complication rate was 7.14 percent. Two (1.8 percent) wound infections, two wound breakdowns, three (2.7 percent) collections, and one (0.9 percent) recurrence were recorded. The collections were reduced to zero after first eight cases by using a suction drain. Sixty-eight of the patients (60.7 percent) had body weight over 90 kg, and the mean body mass index was 24.8. The mean hospital stay was 2.6 days, and the mean time off work was 12.4 days. The average healing time was 13.2 days. There were no anesthetic or surgical deaths. CONCLUSION: The natal cleft is flattened and the incision scar and the incision line is transferred from the midline to the lateral side by performing the asymmetric excision and primary closure, and thus the essential cause of pilonidal sinus is eliminated. The procedure is simple, the complications and recurrences are very low, and it is seen to be an excellent procedure in the surgical treatment of uncomplicated pilonidal sinus disease.

Investigation of CTLA‐4 and CD28 gene polymorphisms in a group of Turkish patients with colorectal cancer

Colorectal cancer (CRC), also called colon cancer or bowel cancer, includes cancerous growths in the colon, rectum and appendix. The immune system is an important defence mechanism against cancer and is often dysfunctional in patients with malignancies. Cytotoxic T lymphocyte‐associated antigen‐4 (CTLA‐4) and CD28 genes encode receptors that provide negative and positive signals, respectively. Polymorphisms in these genes can affect their functions. In this study, we aimed to investigate the association of cancer with the frequencies and roles of CTLA‐4/+49A > G (exon 1) and –318C > T (promoter), and CD28/IVS3 + 17T > C (intron 3 position + 17). These polymorphisms were genotyped using polymerase chain reaction‐restriction fragment length polymorphism (PCR‐RFLP) in 218 Turkish subjects (56 patients with CRC and 162 healthy controls). No statistically significant differences in the genotype distributions of CTLA‐4/+49GG (1.8% vs. 6.8%, odds ratio (OR) = 0.250, P = 0.305) and CTLA‐4/−318TT (0% vs. 0.6%, OR = 1.006, P = 1.000), and CD28/IVS3 + 17CC (8.9% vs. 3.7%, OR = 0.2411, P = 0.155) between patients with CRC and healthy controls, were observed. We also found that there were no significant differences in the frequencies of CTLA‐4/+49G (18.8% vs. 20.1%, OR = 0.920, P = 0.891) and CTLA‐4/−318T (7.1% vs. 4.3%, OR = 1.653, P = 0.314), and CD28/IVS3 + 17C alleles (25.9% vs. 19.1%, OR = 1.353, P = 0.139) between two study groups. Present results suggested that CTLA‐4 and CD28 gene polymorphisms did not play an important role in Turkish patients with CRC.

Systemic stress responses after laparoscopic or open hernia repair.

OBJECTIVE To compare systemic stress responses after laparoscopic and open hernia repair to find out if the laparoscopic approach caused less stress than an open operation. DESIGN Prospective randomised trial. SETTING Teaching hospital, Sanliurfa, Turkey. SUBJECTS 50 patients who required preperitoneal hernia repair were randomised to be treated by either the open or laparoscopic approach (n = 25 in each). INTERVENTIONS Samples of venous blood were taken before operation and at 2, 24, and 48 hours afterwards for measurement of the concentrations of: glucose, cortisol, malonyldialdehyde (MDA), C-reactive protein (CRP), creatine phosphokinase (CPK), caeruloplasmin, transferrin, fibrinogen, and albumin, and counts of leucocytes, neutrophils, and lymphocytes. MAIN OUTCOME MEASURES Changes in these indicators of a stress response. RESULTS Concentrations of glucose, cortisol, CRP, MDA, and CPK, and counts of leucocytes and neutrophils increased significantly, and the concentration of albumin decreased significantly, in both groups postoperatively. Lymphocyte counts were lower postoperatively but not significantly so. Concentrations of CRP, MDA, and CPK, and leucocyte counts were significantly lower in the laparoscopic group. CONCLUSION These findings suggest that there is less systemic stress response after laparoscopic than after open hernia repair.

Effects of antiadhesive agents on the healing of intestinal anastomosis.

PURPOSE: The effects of antiadhesive agents on the healing of intestinal anastomosis were investigated. METHODS: Eighty rats were divided into eight groups. Colotomy and anastomosis were performed to all rats. Saline solution (control), carboxymethylcellulose, aprotinin, verapamil, tenoxicam, cyclosporine, and dextran 70 were administered intraperitoneally. Vitamin E was administered intramuscularly. The rats were killed 15 days later. Anastomotic healing was assessed by bursting pressure and the hydroxyproline content of the anastomotic tissues. The results were evaluated by Mann-WhitneyU test. RESULTS: The mean (± standard deviation) bursting pressures of carboxymethylcellulose, cyclosporine, and aprotinin groups (108 ± 6.73, 122.5 ± 14.39, and 127 ± 20.23, respectively) were significantly lower than those of the control group (234 ± 6.19). The mean level of hydroxyproline in the anastomotic tissues was significantly lower in the carboxymethylcellulose and cyclosporine groups (8.92 ± 0.6 and 8.32 ± 0.63) than that in the control group (16.33 ± 0.68). CONCLUSION: These findings indicate that carboxymethylcellulose and cyclosporine had adverse effects on intestinal anastomosis in rats.

Case Report: A Dramatic Response to Ketotifen in a Case of Eosinophilic Gastroenteritis Mimicking Abdominal Emergency

Eosinophilic gastroenteritis (EGE) is an uncommon benign disease characterized by eosinophilic infiltration of the gastrointestinal (GI) tract. It affects adults as well as infants and children (1). It commonly involves the antrum of the stomach and proximal small bowel (2). However, the large bowel may occasionally be involved (3). The etiology of the disease is unknown, but tissue injury in EGE has been shown to correlate with the presenting number of activated degranulated eosinophils (4). The usual symptoms in EGE are abdominal pain, altered bowel habits, diarrhea, nausea and vomiting, and weight loss (5). Although steroid treatment is associated with a high relapse rate, it is the mainstay of therapy, which usually reveals a good response (6). We report a 30-year-old female who presented with symptoms of an acute abdominal picture and was diagnosed with EGE that responded dramatically to ketotifen therapy.

The value of pre-emptive analgesia in the treatment of Postoperative pain after laparoscopic cholecystectomy

Background and Aim: Postoperative pain is an important surgical problem. Recent studies in pain pathophysiology have led to the hypothesis that with pre-operative administration of analgesics (pre-emptive analgesia) it may be possible to prevent or reduce postoperative pain. This study was planned to investigate the efficacy of pre-emptive analgesia on postoperative pain after laparoscopic cholecystectomy. Methods: 45 patients undergoing laparoscopic cholecystectomy were randomized into three groups. Bupivacaine was injected into the area of skin incision before trocar entry and after trocar removal in group 1 and 2, respectively; however, this procedure was not applied to the control group. The pain score of the patients was evaluated by the visual analogue scale (VAS) at 1, 4, 12and 24 h after surgery. The daily analgesic requirement was evaluated in terms of diclophenac sodium (Diclomec, Abdi Ibrahim, 75 mg) intake/day. Analgesics were given to the patients whose VAS was 5 or higher. Results: While there was no significant difference in VAS scores between group 1 and 2, the mean pain scores of these two groups were found to be significantly lower than of the control group although the analgesic requirement of the patients in each group was not statistically significant. Conclusion: Pre-emptive analgesia is as effective as postsurgical local anaesthesia in reducing postoperative pain.

Risk factors associated with gallstone and biliary sludge formation during pregnancy

Aim:  To define the risk factors in gallstone and sludge formation, and to investigate the incidence of gallstone and biliary sludge formation during pregnancy in a group of healthy pregnant women.

Nitroderm TTS® band application for pain after hemorrhoidectomy

PURPOSE: Anal sphincter spasm is believed to play an important role in pain after hemorrhoidectomy. We tested a different form of nitroglycerin: the Nitroderm TTS® band. We investigated its efficacy on posthemorrhoidectomy pain and the relation between pain and anal resting pressure measured preoperatively and postoperatively. METHODS: Thirty-eight hemorrhoid patients were divided into two groups: those with high anal resting pressure were classified as group A (n=24) and those with low anal resting pressure were classified as group B (n=14). After hemorrhoidectomy, Nitroderm TTS® bands were placed into the anal canal in half of the patients in groups A and B (groups A-1 and B-1) and not in the remaining half (groups A-2 and B-2). Anal resting pressure measurement was repeated at the first day and third month postoperatively. Postoperative pain was assessed by linear analog scale, and analgesic consumption was recorded. RESULTS: Preoperative anal resting pressure was 112.0 (range, 95–140) cm H2O in group A-1 and 110.6 (range, 96–138) cm H2O in group A-2. The difference was insignificant. However, on the first postoperative day, anal resting pressures were 88.7 (range, 75–115) and 110.9 (range, 92–135) cm H2O (P=0.0001), and at the third month, they were 76.5 (range, 70–100) and 78.0 (range, 70–105) cm H2O, respectively (P=0.690). Postoperative pain scores were significantly lower in group A-1 than group A-2 (P=0.0001). In the low-pressure groups (B-1 and B-2), anal resting pressures before surgery, on the first postoperative day, and at the third month postoperatively were 70.4 (range, 56–76), 67.4 (range, 50–75), and 67.2 (range, 55–74) cm H2O in group B-1 and 69.8 (range, 58–76), 70.2 (range, 60–76), and 68.4 (range, 60–74) cm H2O in group B-2. The differences were insignificant (P≥0.660). The differences between pain scores in these groups were also insignificant (P≥0.160). CONCLUSION: Nitroderm TTS® bands effectively reduced anal resting pressure and relieved pain in patients with high preoperative anal resting pressure.

The optimal starting time of postoperative intraperitoneal mitomycin-C therapy with preserved intestinal wound healing

BackgroundThere is controversy about the effect of the timing of intraperitoneal administration of chemotherapeutic agents on the healing of intestinal anastomosis. We have investigated the effect on intestinal wound healing of mitomycin-C administered at different times post-operatively.MethodsEighty-four Wistar-Albino female rats underwent ileal resection and end-to-end anastomosis. The rats were randomly selected for intraperitoneal administration of mitomycin-C or saline as follows: mitomycin-C group (n = 65), 2 mg/kg mitomycin-C; control group (n = 13), 10 ml saline. The former was sub-divided into 5 equal groups (A 1–5) and mitomycin-C was administered postoperatively as follows: day 0 (A1), day 3 (A2), day 5 (A3), day 7 (A4) and day 10 (A5). All the rats were sacrificed on the 14th postoperative day and anastomotic bursting pressures and tissue hydroxyproline levels were determined.ResultsFive of the animals died postoperatively: 2 (15.4%) in group A1, 2 (15.4%) in group A2 and 1(7.7%) in group A3. Non-lethal anastomotic leakage was observed in a further five animals: 1 in group A1, 2 in group A2, 1 in group A5 and 1 in the control group. Groups A1 and A2 had significantly lower anastomotic bursting pressures than the other groups (P was <0.05 for each comparison). The anastomotic bursting pressures of group A3, A4 and A5 were comparable with those of the controls (P was >0.05 for each comparison). Tissue hydroxyproline levels in group A1 and A2 were significantly lower than in the controls (P values were <0.05 for each comparison) or the other mitomycin-C sub-groups (P was <0.05 for each comparison).ConclusionsIntraperitoneal chemotherapy impairs intestinal wound healing when applied before the 5th postoperative day. Additional therapeutic approaches are needed to prevent this potentially lethal side effect of early intraperitoneal mitomycin-C administration.